Provider Demographics
NPI:1134103377
Name:FAIRBORN, CHRIS M (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:M
Last Name:FAIRBORN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6427
Mailing Address - Country:US
Mailing Address - Phone:509-326-2772
Mailing Address - Fax:509-327-1405
Practice Address - Street 1:601 W FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6427
Practice Address - Country:US
Practice Address - Phone:509-326-2772
Practice Address - Fax:509-327-1405
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003032152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2034684Medicaid
WA5493150001OtherDME#
WA2034684Medicaid
U05463Medicare UPIN